Surgical Treatment of Talus OCL: Mid- to Long-Term Clinical Outcome With Detailed Analyses of Return to Sport

Schwartz, Andrew M.; Niu, Shuo; Mirza, Faris; Thomas, Ashley; Labib, Sameh A.

doi:10.1053/j.jfas.2021.05.002

Cited by 7 publications

(19 citation statements)

References 47 publications

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“…Table 1 and Table 2 summarize the highlights of the studies and the characteristics of the patients. Among the 16 studies included in the present systematic review, 9/16 studies (56%) performed only the RD technique, compared or not to other surgical techniques [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ], while 7/16 (44%) performed RD procedures with the addition of bone substitutes or bone marrow-derived cells (BMDC) [ 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…The main results were evaluated through clinical scores. The most used instruments for measuring the outcome of treatment in patients, who sustained a complex ankle or hindfoot injury, combined a clinician-reported and a patient-reported part, measuring pain and ankle instability, cartilage lesion grades, quality of life and activity in daily life or sports: American Orthopaedic Foot and Ankle Society (AOFAS) [ 19 , 20 , 21 , 24 , 25 ]; Visual Analogue Score (VAS) [ 20 , 24 , 26 ]; Japanese Society for Surgery of the Foot (JSSF) scale [ 23 ]; Ankle activity score [ 21 ]; International Cartilage Repair Society (ICRS) grade [ 21 , 27 ]; Saxena criteria [ 25 ]; Short Form-12 (SF-12) [ 26 ]; Tegner score [ 26 ]; Marx activity scores [ 26 ]; Naal Sports inventory [ 26 ]; Foot and Ankle Disability Index (FADI) [ 26 ]. …”

Section: Resultsmentioning

confidence: 99%

“…Finally, two studies compared the RD technique with other ones in 57 (21 females and 36 males) patients with a mean age of 37.1 years [ 26 ] and in 27 (17 females and 10 males) patients with a mean age of 16.9 years [ 28 ] affected by medial or lateral OCL of the talus [ 26 , 27 ]. Schwartz et al compared RD with AD or microfracture for small lesions with cartilage loss, osteochondral autograft transfer (OAT) in larger lesions with subchondral plate defects and allograft cartilage implantation in uncontained defects [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

A Systematic Review of the Retrograde Drilling Approach for Osteochondral Lesion of the Talus: Questioning Surgical Approaches, Outcome Evaluation and Gender-Related Differences

Veronesi

Maglio

Brogini

et al. 2023

JCM

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Background: Retrograde drilling (RD) is a minimally invasive surgical procedure mainly used for non-displaced osteochondral lesions (OCL) of the talus, dealing with subchondral necrotic sclerotic lesions or subchondral cysts without inducing iatrogenic articular cartilage injury, allowing the revascularization of the subchondral bone and new bone formation. Methods: This systematic review collected and analyzed the clinical studies of the last 10 years of literature, focusing not only on the clinical results but also on patients’ related factors (gender, BMI, age and complications). Results: Sixteen clinical studies were retrieved, and differences in the type of study, follow-up, number and age of patients, lesion type, dimensions, grades and comparison groups were observed, making it difficult to draw conclusions. Nevertheless, lesions on which RD showed the best results were those of I–III grades and not exceeding 150 mm2 in size, showing overall positive results, a good rate of patient satisfaction, improvements in clinical scores, pain reduction and return to daily activities and sports. Conclusions: There are still few studies dealing with the issue of post-surgical complications and gender-related responses. Further clinical or preclinical studies are thus mandatory to underline the success of this technique, also in light of gender differences.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A Systematic Review of the Retrograde Drilling Approach for Osteochondral Lesion of the Talus: Questioning Surgical Approaches, Outcome Evaluation and Gender-Related Differences

Veronesi

Maglio

Brogini

et al. 2023

JCM

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“… 45 Previous outcomes of arthroscopic microfracture for OLT have been reported based on retrospective data with a small to medium sample sizes (<200 patients). 13 , 23 , 31 , 41 For instance, a case series with 165 consecutive ankles failed to observe any clinically important prognostic factors on functional outcomes of arthroscopic microfracture but indicated trends toward significance for several factors including BMI and symptom duration at baseline. 10 A larger sample size might overcome this problem and further elucidate this issue.…”

mentioning

confidence: 99%

“…In fact, a substantial number of patients could receive these therapies repeatedly after surgery. For the retrospective data mentioned above, 13 , 23 , 31 , 41 the information on adjunct treatments after surgery was generally unavailable. Thus, the impact of serial and longer term application of these therapies after arthroscopic microfracture remains unknown based on currently available literature.…”

mentioning

confidence: 99%

Radiographic and Clinical Outcomes After Arthroscopic Microfracture for Osteochondral Lesions of the Talus: 5-Year Results in 355 Consecutive Ankles

Yang

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Arthroscopic microfracture for osteochondral lesion of the talus (OLT) has shown good functional outcomes in the short and long term. Purpose: To investigate 5-year radiographic and clinical outcomes after arthroscopic microfracture in treatment of OLT and the effectiveness of adjunct therapies including platelet-rich plasma (PRP) and hyaluronic acid (HA). Study Design: Cohort study; Level of evidence, 2. Methods: We prospectively enrolled 432 patients who underwent arthroscopic microfracture for OLT from May 1, 2011, to May 31, 2015. Magnetic resonance imaging (MRI) and weightbearing radiographs were performed annually after the initial surgery. The MOCART (magnetic resonance observation of cartilage repair tissue) score was used to evaluate the structure of the repaired cartilage on MRI, and patient-reported outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale [AOFAS] and the Foot and Ankle Outcome Score) were collected annually. The primary outcome measure was 5-year AOFAS score. We recorded baseline characteristics including age, body mass index (BMI), and lesion size, and other potentially related factors including number of PRP/HA injection and change in BMI from baseline. Results: Included were 355 patients, all with minimum 5-year follow-up data. The overall reoperation rate was 9.0% (32 of 355). According to multivariable analysis, 5-year AOFAS scores were associated with number of PRP injections (correlation coefficient, 3.12 [95% CI, 2.36 to 3.89]; P < .001), BMI at baseline (correlation coefficient, -0.222 [95% CI, -0.363 to -0.082]; P = .002), and mean BMI change from baseline (correlation coefficient, -1.15 [95% CI, -1.32 to -0.98]; P < .001). When comparing number of PRP injections (0, 1-2, or ≥3), we found that patients who had serial PRP injection (≥3 with at least a 3-month interval between injections) had diminished functional and radiographic deterioration over time. Conclusion: Arthroscopic microfracture improved patient-reported and structural outcomes for patients with OLT at 5 years after surgery. Serial PRP injections and reduction in BMI from baseline were able to slow radiographic and functional deterioration. Future trials regarding the combination of microfracture and PRP in treatment of OLT should focus on the efficacy of longer term, intra-articular, serial injections of PRP instead of single injections.

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Advances in retrograde techniques for osteochondral lesions: is there a different path we can take?

Faldini

2024

Musculoskelet Surg

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Surgical Treatment of Talus OCL: Mid- to Long-Term Clinical Outcome With Detailed Analyses of Return to Sport

Cited by 7 publications

References 47 publications

A Systematic Review of the Retrograde Drilling Approach for Osteochondral Lesion of the Talus: Questioning Surgical Approaches, Outcome Evaluation and Gender-Related Differences

A Systematic Review of the Retrograde Drilling Approach for Osteochondral Lesion of the Talus: Questioning Surgical Approaches, Outcome Evaluation and Gender-Related Differences

Radiographic and Clinical Outcomes After Arthroscopic Microfracture for Osteochondral Lesions of the Talus: 5-Year Results in 355 Consecutive Ankles

Advances in retrograde techniques for osteochondral lesions: is there a different path we can take?

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